Age: The rate can differ up to 3:1 for like individuals of different ages who are 21 years and older.
Family Size: Rates may differ based on whether coverage is for an individual or a family.
Geography: States can establish up to seven geographic rating areas to determine the collective health care risk of the residents.
Tobacco Use: Users of tobacco can be charged rates up to 50 percent higher than non-tobacco users.
All other rating factors are prohibited. This means that several factors commonly used by issuers to set higher premiums prior to 2014 (such as health status, claims history, duration of coverage, gender, occupation, small employer size and industry) can no longer be used.
Many employers want to know whether they can determine their own composite rating. However, their authority to do this is unclear at this time, as official guidance from the federal government has yet to be issued.As a result, some issuers no longer determine composite ratings for their group plans.
In response to this, many small employers want to know whether they can determine their own composite rating. However, their authority to do this is unclear at this time, as official guidance from the federal government has yet to be issued.
